Children with Unilateral Hearing Loss Struggle in School

Children born with aural atresia, an ailment characterized by the complete absence of the external ear canal (if only in one ear), are more likely to struggle in school, according to a recent study by researchers at Washington University School of Medicine in St. Louis, published mid July in JAMA Otolaryngology.

Hearing amplification and corrective surgery are available for the hearing condition. However, many children with single ear atresia -- or unilateral hearing loss -- are never treated, under the assumption that having one good ear is adequate. These children experience significant hearing loss in their affected ear.

“Until the 1990s, any kind of hearing loss that occurred in just one ear and was present from birth was not considered a serious disability,” Judith E.C. Lieu, M.D., coauthor of a study of the effects of aural atresia on speech development, told News Medical. “It was assumed that these children would adjust and develop normally. But we know now that isn’t always the case.”

What to Know About Unilateral Hearing Loss

Aural atresia, which occurs in approximately one of 10,000 live births, tends to be accompanied by a malformed or absent external ear. In two-thirds of cases, only one ear – generally the right ear – is affected.

Since atresia-affected ears lack an external ear canal, sound is not conducted to the generally healthy inner ear. Children born with unilateral atresia often have entirely normal hearing in their unaffected ear. Various surgical and amplification techniques that enable sound to reach the child’s inner ear, can restore hearing in the affected ear.

Because aural atresia is an invisible impairment, children with the hearing condition often get mistaken for acting up in class when they simply have trouble hearing the teacher.

“That is part of the problem,” Lieu told News Medical. “Because the child appears normal, it is easy to forget that they have an impairment. A child with unilateral atresia, who fails to pay attention in class or keeps talking when he or she should be quiet, might be labeled a problem student when the real issue is that he or she simply does not hear the teacher.”

Unilateral Hearing Loss Research Efforts

Recent studies have shown that children with unilateral hearing loss from causes other than atresia are more likely than their peers to experience speech and language delays that can affect their school performance. Lieu and her colleagues at Washington University School of Medicine decided to test if the same was true for those with aural atresia.

The researchers examined medical records collected by the Center for Communication Disorders at St. Louis Children’s Hospital over a 35-year period and selected 74 children seen at the clinic from ages two to 12. The majority of the subjects were male and twice as many subjects had right atresia as those with left atresia. Lieu commented that these proportions were consistent with the demographics for children with aural atresia. Seven children of the 74 chosen suffered from bilateral atresia.

Almost all of the subjects had moderately severe hearing loss in the affected ear. Those with unilateral atresia had normal hearing in the healthy ear. While all children with bilateral atresia wore two hearing aids, less than 5 percent of children with unilateral atresia wore a hearing aid.

Using data from speech pathologists’ evaluations, clinic notes by psychologists and nurses and parental reports of speech rates, language delays, speech therapy and educational interventions, the study found that 40 percent of children with unilateral atresia required speech therapy and 25 percent experienced learning difficulties.

Interestingly enough, while children with bilateral atresia received speech therapy, none of them experienced issues with academic performance.

“This may be because their impairment was more fully appreciated and addressed and their learning environment was modified,” said Lieu.

Those with right atresia experienced more academic performance issues than those with left atresia. In previous studies, almost 35 percent of those with right unilateral hearing loss had repeated a grade, compared to less than 7 percent of children with left atresia.

Researchers recommend ongoing monitoring of children with unilateral atresia for early signs of speech or academic issues.

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